Provider Demographics
NPI:1295944437
Name:GOODSTEIN, MAANGELICA (PT, DPT, PA-C)
Entity type:Individual
Prefix:MRS
First Name:MAANGELICA
Middle Name:
Last Name:GOODSTEIN
Suffix:
Gender:F
Credentials:PT, DPT, PA-C
Other - Prefix:MS
Other - First Name:MA ANGELICA
Other - Middle Name:EUGENIO
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, PA-C
Mailing Address - Street 1:720 PEACHY CANYON CIR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0894
Mailing Address - Country:US
Mailing Address - Phone:702-758-4110
Mailing Address - Fax:
Practice Address - Street 1:3900 PARADISE RD STE V
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-0930
Practice Address - Country:US
Practice Address - Phone:702-369-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2497225100000X
NV1227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty